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• Depersonalization Disorder

• depersonalization disorder – when feelings of unreality are so severe and frightening that
they dominate an individual's life and prevent normal functioning (can be part of many
disorders, but when it is a primary problem = depersonalization disorder)
• these symptoms can occur during a panic attack, or when undergoing intense
stress/experiencing traumatic event called acute stress disorder
• depersonalization disorder split between men and women, symptoms pg 191, mean age of
onset is 16, chronic disorder, anxiety, mood, and personality disorders common in these
individuals as well
• normal people and those with disorder compared, both have equal intelligence but
disordered people have cognitive deficits in attention, short-term memory, and spatial
reasoning (can't see 3D)
• correspond with reports of “tunnel vision” (perceptual disorders) and “mind
emptiness (difficulty absorbing new info)
• also have greatly reduced emotional responding, reflects tendency to selectively
inhibit emotional expression, deficits in perception and emotional regulation as
shown by deficits in HPA axis
• psychological treatments have not been studied, Prozac has no effect
• Dissociative Amnesia
• generalized amnesia – people are unable to remember anything, including who they are,
may be lifelong or extend from a period in recent past
• localized or selective amnesia – a failure to recall specific events, usually traumatic, that
occur during a specific period – this dissociative amnesia is common during war
• ex. pg 192 – women does not have amnesia for the events themselves but rather for her
intense emotional reactions to the events – absence of emotional experience
• forgetting mostly selective for traumatic events/memories, not just generalized
• Dissociative Fugue
• dissociative fugue – fugue means flight, in these cases, memory loss revolves around a
specific incident – an unexpected trip (or trips) – most people just take off and later find
themselves in a new place, unable to remember why or how they got there
• they usually leave behind an intolerable situation, during trips person sometimes assumes
new identity or becomes confused about old identity
• seldom appears before adolescence (both fugue and amnesia), most occur in adulthood,
once they appear, continue to old age, don't start after age 50
• fugue states end abruptly, person returns home, recalling most, if not all, of what
happened – the memory loss/ identity loss occurs during disintegrated experience
• also amok – running disease, enters trancelike state and suddenly with a source of
energy runs/flees for a long time – not in US
• Dissociative Trance Disorder
• dissociative trances occur in India, Nigeria, Thailand, many other cultures around the world
• not in DSM-IV as trance and possession not seen in US, but very common dissociative
disorder elsewhere
• Dissociative Identity Disorder
• dissociative identity disorder – people may adopt as many as 100 new identities, most
develop 15, some identities are complete with own behavior, tone of voice, and physical
gestures – most identities are only partially independent and only few characteristics are
distinct, so name in DSM-IV changed from multiple personality disorder to DID
• Clinical Description
• Jonah – during “headaches” he claimed other names, acted differently, and seemed to be
another person completely – identity/personality in DID is called an alter
• ex. pg 194, Jonah knows nothing of alters – each identity created at time of trauma for
protection and other reasons
• DSM-IV for DID – amnesia, identity fragmented/ certain aspects dissociated
• Characteristics
• the person who becomes the patient and asks for treatment is the “host” identity
• host personalities attempt to hold various fragments of identity together but end up
being overwhelmed, first personality to seek treatment is seldom original personality, as
host personality develops later
• may patients have at least one impulsive alter who handles sexuality and generates
income (prostitute), all other alters abstain from sex, cross-gendered alters common
• transition from one personality to another = switch, it is instantaneous, physical
transformations can occur, like changes in posture, facial expressions/wrinkling,
physical disabilities, changes in handedness
• Can DID Be Faked?
• Is DID (fragmented identities) real or do people fake them to avoid responsibility/stress
• hard to answer
• 1. people with DID are suggestible, and it is possible that alters are created in
response to leading questions from therapists – ex. pg 195
• simulate alters to avoid conviction, faker tend to overcompensate, fakers often
have no memory of other alters, patients with ED suggest memories are different
from one alter to the next
• real symptoms of DID could mostly be accounted for by therapists who
inadvertently suggested the existence of alters – called “socio-cognitive model” b/c
possibility of identity fragments and early trauma is socially reinforced by therapist
• many therapists don't think DID should be included in DSM-IV at all
• other studies show that people with fragmented identities are not consciously and
voluntarily simulating – many have optical changes that are difficult to fake, also
changes in brain function, different psychological responses
• fakers usually eager to demonstrate symptoms and do so in a fluid pattern, patients
with DID more likely to try to hide symptoms
• Statistics
• average number of alter personalities is 15, 9:1 female to male ratio, onset in childhood,
as young as four, but diagnosed 7 year after appearance of symptoms
• lasts a lifetime without treatment, frequency of switching personalities decreases with
age, but different personalities may emerge in response to new life situations
• prevalence rates = 3 to 6% in North America, more common than previously thought
• many patients have simultaneous psychological disorders such as anxiety, substance
abuse, depression, and personality disorders – called comorbidity
• why? All diseases mostly a result of horrible child abuse
• b/c auditory hallucinations are common in DID, it is often misdiagnosed as
psychotic disorder, but voices in DID are coming from inside their heads, not outside
• Causes
• almost every patient (97%) presenting with DID reports being horribly abused as a child
• physical/sexual assault, incest, can also be caused by horrible trauma
• child has no way of knowing it is unusual/wrong
• the one think kids can do is escape into fantasy world, be somebody else, and if the
escape makes the next hour bearable or blunts the physical/emotional plain more a
minute, you will “escape” again – no limit to identities, they can be created as needed
• DID is rooted in a natural tendency to escape of “dissociate” from the unremitting
negative affected associated with abuse
• caused by chaotic, non supportive family, lack of social support exists, individual
experience and personality also contribute
• many people have experienced some type of dissociation, such as feelings of
unreality, a blunting of emotional and physical pain, and even separation from their
bodies – amnesia and fugue are reactions to severe life stress, but these are related to
life stressors in the present, not the past, like DID
• but DID pathological, need specific vulnerabilities (a diatheses) to react to stress with
pathological dissociation
• somewhat similar to PTSD, DID may be a extreme subtype of PTSD with greater
emphasis of dissociation than anxiety
• after 9 years of age vulnerability to DID is very small but we still know very little
• Suggestibility
• suggestibility is a personality trait, some are more than others
• people with imaginary playmate are considered more suggestible or easily hypnotized
• a hypnotic trance is similar to dissociation – in a trance, person is focused on one aspect
of the world and vulnerable to suggestions of hypnotist
• also self-hypnosis – people can dissociate from world and suggest to themselves that
they won't feel pain, for example
• autohypnotic model – people who are suggestible use dissociation as a defense against
extreme trauma, people who aren't develop PTSD
• 50% of DID patients had imaginary playmate, and when trauma unbearable,
personality splits into multiple dissociated identities, kids ability to distinguish
between fantasy and reality as they grow older closes developmental window for
developing DID at age 9
• Biological Contributions
• certainly biological vulnerability but hard to pinpoint – twin studies, none of causes
attributable to heredity, all was environmental –epilepsy stuff/brain pg 199
• Real Memories and False
• to what extent are memories of early trauma, particularly sexual abuse, accurate?
• Some think memories are result of strong suggestions by careless therapists who
assume people with condition have been abused – this can create problems
• these false memories (which can be created by psychological processes, shown
page 199) can lead to false accusations against loved ones
• on the other hand, if sexual abuse did occur with is not remembered b/c of dissociative
amnesia it is very important to re-experience aspects of trauma with therapist to relieve
current suffering or DID will never be treated
• young kids also unreliable when reporting accurate event details
• false memory creation experiments pg 200
• in sum, there are two types of memories – traumatic memories that can be dissociated
and normal memories that cannot, although they can be forgotten
• need to be able to detect difference between implantation of false memories and real but
dissociated trauma
• Treatment
• people w/ dissociative amnesia or fugue usually get better on their own and remember
what they have forgotten – their episodes are so clearly related to current life stressors
that theory resolutions involve distressing situations and increasing coping mechanisms
• recall what happened during amnesia w/ help of family so parents can confront info
and integrate it into conscious experience
• for more difficult cases, hypnosis or benzodiazepines used
• with DID, reintegrating personality might seem hopeless, sometimes works with long-
term psychotherapy, 5 out of 20 have full personality integration
• strategies of therapy – goal is to identify cues/triggers that provoke memories of trauma,
dissociation, or both and to neutralize them
• patient must relive early trauma and gain control over horrible events as they recur
in the mind – need to visualize and relive trauma until it is a terrible memory instead
of a current event
• unconscious, so memory unknown until it emerges in treatment –hypnosis often use
to access traumatic memories, has some effectiveness
• it is possible that reemerging memories may trigger more dissociation, needed trusting
relationship with therapist
• sometimes meds are combined but little evidence that this helps, antidepressants might
be appropriate in some cases